1. By: Emily Logan & Cassie Hagenauer
Herpes Zoster
By: Emily Logan & Cassie Hagenauer

2. History of Shingles
-There have been reported cases of shingles for over 100 years, though it is thought that while the earliest cases of shingles are over 250 years old, it is difficult to tell how many there were because the shingles rash was confused with the rash present in smallpox and chickenpox.
-It was only in 1767 that scientist William Heberden was able to distinguish shingles from smallpox.
-The origin of shingles was first discussed in 1831, when a scientist named Richard Bright stated that he believed the disease was carried by the dorsal root ganglion, or the spinal ganglion.
-In 1888, it was suggested by Viennese doctor Jonas Von Bokay that the shingles virus and the chickenpox virus came from the same bacterial group, but it was not studied until 1953 by Thomas Weller and the connection was confirmed in lab experiments.
-Shingles is also known by the name “herpes zoster.”
-Shingles is caused by the Varicella Zoster virus which is the same virus that causes chickenpox.
-Shingles can develop only after initial infection with chickenpox, or, more commonly, after Varicella virus.

3. The Virus -Family: Herpesviridae -Genus: Varicellovirus
-Non motile and have no staining characteristics due to being a virus
-The size of Varicella-Zoster Virus is about nm
-The most important virulence factor to note with shingles is the virus’s ability to establish a latent Varicella-Zoster viral infection in the dorsal root ganglia which allows the infection to reemerge at a later time in the form of herpes zoster (shingles).

4. Pathophysiology
-After a person has had chickenpox, the virus remains dormant in the body, in nerve tissue near the spinal cord and brain. It may reappear at any time in the form of shingles, or never, depending on the person's health.
-During an outbreak, only those who have not had chickenpox before are susceptible.
-Shingles are infectious until all blisters have crusted over. If someone becomes infected by exposure to shingles, symptoms will appear in 14 to 21 days in the form of chickenpox.
-Shingles produces painful blisters, and is characterized by a rash on one side of the body.

5. Transmission
-Shingles cannot be passed from one person to another. However, the varicella zoster virus, can be spread from a person with active shingles to another person who has never had chickenpox. In such cases, the person exposed to the virus might develop chickenpox, but they would not develop shingles.
-Transmission occurs via the fluid from the shingles blisters. A person is infectious from the time the blisters appear to the time the blisters crust over and no longer contain fluid.
-Since humans are the only known host of the virus, there are no vectors.

6. Case Subjects Story
One Monday morning our subject woke up with a sharp pain in her eyelid. She assumed it had been because of her allergies so she just brushed it off and dealt with the pain and later took allergy medicine for it. A few days later with the pain not going away, another symptom arose, her eye was now swollen. So she decided she better heat pack it with a hot wash rag. That worked for a couple of days but the swelling just kept coming back minutes after the swelling would go down. She soon got blurry vision after that and decided it was time to go to the doctor and see if she had an infection.
Based on a True Story
Time of Occurrence March 7th, 2016

7. Case Subjects Circumstances and Symptoms
Female
19 years old
Allergic to Pollen
Asthma
No Chickenpox Vaccination
Weakened immune system
High stress level
Symptoms:
Swollen Eye Itchy
Blisters Red Splotches on Forehead
Redness Loss of eyelashes
Blurry Vision
Pain
Tender Lymph Node

8. Case Subjects Course of Action
Immediate Course of Action:
Personal:
Allergy Medicine
Heat packing the eye
Doctors:
Antibiotics

9. Case Subject Story (Continued)
The doctor decided that it was an infection and gave her trimethoprim- polymyxin eye drops to help get rid of the infection. He told her if it got any worse to call in an oral antibiotic called Cephalexin to help kick the eye infection. While taking the eye drops she had noticed a little rash and bumps and thought it was just eczema or possibly acne appearing on her forehead. So she had then popped the bumps because what harm could she do since she thought it was only acne. By the following Monday her eye was swollen shut when she woke up and more bumps had appeared on her face, but only on the right side. The bumps on her forehead made a hard straight line down the middle not entering onto the left side of her face. So she decided to call the doctor and go back in since the bumps weren’t there the first time she went in.

10. 2nd Diagnosis
-With the fluid filled blisters and the swollen eye combination the Doctor determined that it was SHINGLES.
New Prescriptions:
Valatrex
Hydrocodone (for Pain)

11. Story (Continued)
After being diagnosed with Shingles, her primary care doctor referred her to her eye doctor to check everything out there and make sure no lesions had started to appear on her cornea and optic nerve and to check her eyesight and make sure that the lesions didn’t affect her eyesight.
Eye Doctor Diagnosis:
-Everything looked good no signs of lesions on the eye, but would most likely experience light sensitivity in the future
-New prescription (Tobrex Ointment) to help fight off any other possible eye infections that could occur.

12. Story (Continued)
After a week of taking the medications the physical symptoms subsided. All that was left was crusted over blisters that soon turned into scars and nerve pain from damaged nerve endings.
Since the pain still exists the subject is on a nerve pain medication called Gabapentin to help treat the nerve pain. She is also putting Mederma on her scars to make them less noticeable.
She continues to have trouble with light sensitivity and blurred vision at times in her right eye even though there were no lesions on her eye or optic nerve. As far as the subject knows she did not spread her shingles.
SURPRISE the subject is Cassie

13. Diagnosis
-Appearance of blisters and swelling is the primary characteristic of diagnosis
-Tests that can be conducted are most commonly Herpes Tests on cells taken from the blisters.
-Herpes Tests, test the fluids that come from the blisters.

14. Cases
Number of cases in the U.S. are estimated to be 1 million
About half are men and women over the age of 60
This is a nonreportable disease, this means that it is hard to know exact numbers on how many cases there are every year.
Importance
-It is important to study this disease because shingles are starting to be seen in younger adults more often now.
- “The reason, experts say, is that vaccines have, paradoxically, rendered an unlucky cohort more vulnerable.”

15. References
“Varicella zoster virus.” Citizendium. N.p., 14 May Retrieved 8 July <en.citizendium.org/wiki/Varicella_zoster_virus>.
-(virus picture and information about genome structure, discovery, and taxonomy)
“Shingles (Herpes Zoster).” Centers for Disease Control and Prevention. N.p., 15 Mar Retrieved 8 July <cdc.gov/shingles/about/overview.html>.
-(cause, transmission info, signs and symptoms, treatment and prevention)
“Varicella-zoster virus.” Microbe Wiki. N.p., 11 Feb Retrieved 8 July <microwiki.kenyon.edu/index.php/Varicella-zoster_virus>.
-(pathophysiology picture, virulence factor, diagnosis, symptoms)
“Shingles (Herpes Zoster).” The History of Vaccines. N.p., 9 Feb Retrieved 8 July <historyofvaccines.org/content/articles/shingles-herpes-zoster>.
-(complications, available vaccines, transmission)
“History of Shingles Disease.” eHow. N.p., n.d. Retrieved 8 July <ehow.com/facts_ _history-shingles-disease.html>.
-(history, prevention)

16. References
Overview. (2016). Retrieved July 11, 2016, from
-(Statistic on Herpes Zoster)
Why are ever-younger adults contracting shingles? - Macleans.ca. (2010). Retrieved July 11, 2016, from at-risk/
-(The reason why young adults are getting shingles)